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AIDS first emerged as a major global issue in 1981. At this time, there were no viable treatments and the disease itself, as well as the way it spread, was highly misunderstood. AIDS has affected and continues to affect many countries worldwide, including the US, South Africa, and India. While treatment has greatly improved over the years, especially in developed countries, and life expectancy has drastically increased, there is still no cure and millions live with this chronic condition. The differing strengths of the economies greatly affect the availability of treatment, awareness of the disease, and knowledge of ways to prevent it throughout the three countries..
The first cases of AIDS in the United States emerged in 1981 (Dandona). At this time, nothing was known about the disease. People did not know how it spread, and it was widely believed that it affected only homophobic people, earning it the name “gay cancer” (Christensen). No treatment options were available and because no one knew the way in which it spread and many people were very cautious, some even avoiding shaking hands for fear that they would be infected. Many health care workers refused to care for patients with AIDS, fearing that they would become infected. At first, there was not enough support for the disease and therefore not enough funding for scientists to successfully research it, partly because many assumed only gay people could be affected. Congress would not dedicate any funds towards research of the disease until 1983, two years after it first emerged. Gradually, awareness increased, and with it money for research. In 1984, three years after the initial outbreak, Dr. Robert Gallo finally found the retrovirus that causes AIDS. In 1987, the first antiretroviral drug was approved by the FDA to treat AIDS (A Timeline of HIV and AIDS).
How it works
Today, in the United States, almost everyone has heard of AIDS and knows what it is. Due to this increased awareness, people are better able to protect themselves from getting the disease. Furthermore, many people who are diagnosed quickly receive treatment. However, there are still many racial disparities when it comes to HIV. HIV is much more prevalent in those who are African American or Hispanic than it is in those who are white. Gay people are also more affected than their straight counterparts. According to the CDC, in 2016 76% of the people who were diagnosed with HIV were connected to a place where they could receive medical care within one month of their diagnosis (HIV/AIDS).The Henry J. Kaiser Family Foundation says, “while many people with HIV are diagnosed (86%), far fewer receive medical care (63%), and fewer still are virally suppressed (51%)” (The HIV/AIDS Epidemic in the United States…). Unfortunately, the stigma around the virus prevents many people from obtaining treatment and being properly educated on how to prevent the virus. Part of the reason so many people who are diagnosed have access to good treatment is because of the strong economy that the United States has. This allows them to allocate more money towards awareness and treatment of AIDS than other countries that have weaker economies. In 2019, the US Government will spend $34.8 billion on AIDS, which will be used both globally and domestically (U.S. Federal Funding for HIV/AIDS: Trends Over Time). This money enables many people who otherwise would not be able to afford treatment to receive the treatment they need.
It was not until 1986 that the first case of AIDS in India was reported. Until 2004, the Government of India focused its efforts on preventing the spread of the disease rather than the treatment of those already infected. It was not until 2007 that free ARV drugs began being distributed by the government (Jain). Today the HIV epidemic in India constitutes the third largest epidemic in the world. This is mainly due to the fact that they have such a large population, as only 0.2% of adults have the disease (HIV and AIDS in India). The large population also makes it very difficult to get an accurate measurement of the number of people living with HIV or AIDS, as well as the number of people who have died because of it (Jha). India has been making a great effort to educate the population about HIV and actions they should take to prevent it. Some of the most high-risk groups in India include Female Sex Workers (known as FSWs), transgender people, injecting drug users, gay men, and truckers (Sharma). While the percentage of people in these groups who have gotten HIV has decreased due to government intervention efforts targeting these groups, they still remain high (Dandona). Unfortunately, only 32% of men and 22% of women aged 15-24 knew how they could prevent HIV. A program called NACP-IV hopes to lower the number of new HIV infections by 50% by focusing on making more people aware of the disease and how it can be prevented (HIV and AIDS in India).
The percentage of people who have HIV and are being treated for it is only 56% and only 79% of people who have AIDS are aware that they have it (HIV and AIDS in India). The amount of people being treated in India is less than that of the United States. Unfortunately, sex workers and gay men are highly stigmatized groups in India. Sometimes, this stigma and discrimination affects the health care they recieve. People in these groups have reported having been refused treatment and pregnant women have reported being denied admittance to hospitals for delivery. One gay man said “Some of the doctors, when we approach them for treatment, if they know that we are [kothis] they don’t touch us and go away from us, ordering the [security staff] to send us out” (Reducing HIV Risk Behaviors…). This discrimination likely plays a large role in the lower percent of people with HIV engaging in treatment. Since 2017, India has been using a policy called “test and treat”. This ensures that anyone diagnosed with HIV is eligible to be treated. Even though money is no longer a major obstacle for many people with HIV, not everyone has access to clinics, making it difficult for them to obtain treatment (HIV and AIDS in India).
India is currently undergoing a period of development, with the hope of becoming a high middle-income country by 2030. While the amount of people living in extreme poverty has dropped drastically, about 13.4%, or 176 million people, continue to live in poverty. Like other countries, India has been increasing their domestic spending on HIV, therefore requiring less international aid (The World Bank In India). They now pay for 80% of their National HIV Program (Funding for HIV and AIDS). However, because there are so many poor people, many of them do not have access to information about AIDS and remain uneducated about the virus.
AIDS first appeared in South Africa in 1982. Until 1994, the government did not do much to contain it. It was not until 1989 that heterosexual population began being diagnosed with HIV, and soon after that, the number of heterosexuals diagnosed with HIV exceeded the number of homosexuals with the disease (Abdool Karim). Today, the HIV epidemic in Africa is the largest in the world. As a result of this, South Africa’s treatment program consists of 20% of people being treated with antiretroviral therapy, making it the largest in the world. Like in India, the rates of HIV are highest among sex workers and gay men (South Africa). HIV is also very stigmatized in South Africa and people often do not talk about it with others (Baker). Due to this, many people do not get tested for it and therefore do not know if they have it (HIV/Aids in South Africa). This is something that Sithole-Spong, a woman living with HIV in South Africa, feels needs to change in order to decrease the rate of HIV diagnoses, saying “That is how we will reduce new HIV infections because then the HIV-positive people will not feel a need to hide it. They will use protection, they will be more aware of themselves, and they will be more confident”.
Unfortunately, while South Africa’s treatment program is very large, the health care system is still not properly equipped to deal with the epidemic (Abdool Karim). Access to ARVs has greatly increased. In 2000, only the wealthiest people could afford treatment. Today, treatment is much more affordable, but the HIV virus is fully suppressed in only about a quarter of the people who have the disease. Furthermore, only half of the people who have AIDS or HIV are being treated. The government only provides treatment for people who have damaged immune systems, there are many people who do not know that they have the virus, and many people start treatment but then stop (Cohen). The South African health system is struggling to deal with the influx of new patients, many of whom are young and normally would not have needed additional health services (Abdool Karim).
While treatment for AIDS has greatly improved in South Africa, the country still has a long way to go. As is also the case in many other countries, they must get rid of the stigmas surrounding AIDS before they can adequately educate the population on the prevention and treatment of the virus, as well as the importance of getting tested. Furthermore, the health care system must begin providing care for everyone and ensuring more people who begin treatment remain in it. It is especially important to encourage people to continue treatment because once the disease is fully suppressed it will not be transmitted to others (Viral Suppression for HIV Treatment…). This will help prevent more people from becoming infected. By 2020, South Africa hopes to reach their 90-90-90 goal, which is “to have 90% of infected people aware of their status, 90% of known positives start ARVs, and 90% of that group drive the amount of virus in their bloodstream down to undetectable levels” (Cohen). South Africa already receives $300 million from other countries. In 2019, South Africa will be adding an additional $65 million to the $1.2 billion that they already spend each year on AIDS (Cohen).
South Africa has a strong economy. According to the World Bank, their economy is upper-middle income. Unfortunately, one out of four people are unemployed and the gap between the rich and the poor is substantial and only increasing (The South African Economy). This large wealth gap makes it difficult to reach all of the people and educate them about ways to prevent and treat the disease. The amount of people with the virus on treatment is 68%, which is more the India but less than the US (HIV and AIDS in South Africa).
While the US, India, and South Africa have all made big strides in the prevention and treatment of AIDS, each country still has a ways to go. The stigma surrounding the disease in all three countries significantly impacts the amount of people being treated for the disease, as well as the amount of people remaining on treatment. Decreasing the stigmas will also allow those who have the disease to talk to others about it and educate them on preventative measures they can take. The differing economies of these countries impacts the availability of treatment as well as knowledge of the disease, and therefore influences the percentage of those who have AIDS who are aware of their diagnosis and who are in treatment. The wealth disparity between the upper and lower class, especially in South Africa and India, also affects treatment and knowledge of the virus.
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